Provider Demographics
NPI:1881823177
Name:ALEXANDER, JEFFREY LEWIS (IDMT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:LEWIS
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
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Mailing Address - Street 1:4700 LAS VEGAS BLVD N
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89191-6600
Mailing Address - Country:US
Mailing Address - Phone:702-653-2230
Mailing Address - Fax:702-653-2110
Practice Address - Street 1:4700 LAS VEGAS BLVD N
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89191-6600
Practice Address - Country:US
Practice Address - Phone:702-653-2230
Practice Address - Fax:702-653-2110
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians